Healthcare Provider Details

I. General information

NPI: 1205926342
Provider Name (Legal Business Name): RUTH A MCKINDLES CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 CRESTVIEW DR
OSWEGO IL
60543-9512
US

IV. Provider business mailing address

84 CRESTVIEW DR
OSWEGO IL
60543-9512
US

V. Phone/Fax

Practice location:
  • Phone: 630-554-7245
  • Fax: 630-554-7245
Mailing address:
  • Phone: 630-554-7245
  • Fax: 630-554-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: